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Wanneer was die eerste sterftes as gevolg van die Spaanse griep -pandemie?

Wanneer was die eerste sterftes as gevolg van die Spaanse griep -pandemie?

Ek het inligting gevind oor die eerste koerantartikels met inligting oor die Spaanse griep -pandemie, maar een van die aanhalings uit die koerant sê:

Die epidemie is van 'n ligte aard; geen sterftes is aangemeld nie”.*

Dit is vanaf April in 1918.

Ek wonder net wanneer die eerste verslag oor sterftes as gevolg van die siekte gebeur het?


Dit is onmoontlik om met enige sekerheid te verklaar omdat:

  1. Die presiese pad van die "Spaanse" griepvirus in sy vroeë stadiums is onbekend; en
  2. Vroeë sterftes as gevolg van die virus is destyds nie erken nie en het min aandag gekry.

Beskikbare bewyse dui daarop dat die Spaanse griep regoor die wêreld in 'n aantal gelokaliseerde uitbrake oor die hele wêreld 'gesaai' is, net voor die massadood wat in 1918 plaasgevind het.

Berigte oor griepsterftes in lande wat so wyd versprei is as Noorweë, Swede, Finland, Kanada, Spanje, Brittanje, Frankryk, Duitsland, Senegal, Tanzanië, Nigerië, Ghana, Zimbabwe, Suid -Afrika, Indië en Indonesië is opgeteken. Die baie wye geografiese verspreiding van hierdie sterftes in so 'n kort tydperk, in die afwesigheid van lugreise, dui daarop dat die siekte voor hierdie tyd oor die hele wêreld versprei het en dat 'saai' plaasgevind het.

Oxford, J. S., et al. "Vroeë heraldgolfuitbrake van griep in 1916 voor die pandemie van 1918." Internasionale kongresreeks. Vol. 1219. Elsevier, 2001.

Finland het in 1917 buitengewoon hoë vlakke van longontsteking aangeteken; in Brittanje het die Bochum Administration of Sick Insurance in 1916 'n toename van 40% in griepgevalle gerapporteer; en 'n groot epidemie van respiratoriese siektes aan die einde van 1915 deur die Verenigde State.

Alhoewel griep in 1918 nie 'n nasionaal aanmeldbare siekte was nie en diagnostiese kriteria vir griep en longontsteking vaag was, het die sterftesyfer as gevolg van griep en longontsteking in die Verenigde State in 1915 en 1916 skerp gestyg weens 'n ernstige epidemie van respiratoriese siektes wat in Desember 1915 begin het

Taubenberger JK, Morens DM. 1918 Griep: die moeder van alle pandemies. Opkomende aansteeklike siektes. 2006;12(1):15-22.

Daarom is dit moontlik dat die eerste groot uitbraak van sterftes nie later as Desember 1915 plaasgevind het nie. Die letterlike eerste gevalle van sterftes van toe die virus opgeduik het, is onmoontlik om met presisie vas te stel, maar het moontlik plaasgevind toe die virus die eerste keer gespring het mense van voëls of varke, moontlik van 1913 tot 1915.


Bakteriële longontsteking het die meeste sterftes veroorsaak in 1918 grieppandemie

Die meerderheid sterftes tydens die grieppandemie van 1918-1919 is nie veroorsaak deur die griepvirus wat alleen optree nie, berig navorsers van die National Institute of Allergy and Infectious Diseases (NIAID), deel van die National Institutes of Health. Die meeste slagoffers het eerder aan bakteriële longontsteking beswyk ná griepvirusinfeksie. Die longontsteking is veroorsaak toe bakterieë wat gewoonlik in die neus en keel woon, die longe binnedring op 'n pad wat ontstaan ​​het toe die virus die selle wat die brongiale buise en longe voer, vernietig het.

'N Toekomstige grieppandemie kan op 'n soortgelyke manier ontvou, sê die NIAID -skrywers, wie se artikel in die 1 Oktober -uitgawe van Die Journal of Infectious Diseases is nou aanlyn beskikbaar. Daarom kom die skrywers tot die gevolgtrekking dat omvattende pandemievoorbereidings nie net pogings om nuwe of verbeterde griep -entstowwe en antivirale middels te produseer, insluit nie, maar ook voorsiening vir die opberging van antibiotika en bakteriële entstowwe.

Die werk bied aanvullende bewyse uit die velde van patologie en geskiedenis van medisyne om hierdie gevolgtrekking te ondersteun. "Die gewig van die bewyse wat ons ondersoek het uit beide historiese en moderne ontledings van die grieppandemie van 1918, bevoordeel 'n scenario waarin virusschade gevolg deur bakteriële longontsteking tot die oorgrote meerderheid sterftes gelei het," sê mede-outeur, direkteur van NIAID, Anthony S. Fauci, MD "In wese het die virus die eerste slag gekry terwyl bakterieë die uitklophou gegee het."

NIAID, mede-outeur en patoloog Jeffery Taubenberger, MD, Ph.D., het longweefselmonsters ondersoek van 58 soldate wat in 1918 en 1919 aan verskillende Amerikaanse militêre basisse gesterf het. Die monsters, wat in paraffienblokke bewaar is, is weer gesny en gekleur om mikroskopiese evaluering moontlik te maak. Die ondersoek het 'n spektrum weefselskade aan die lig gebring "wat wissel van veranderinge wat kenmerkend is van die primêre virale longontsteking en bewyse van weefselherstel tot bewyse van ernstige, akute, sekondêre bakteriële longontsteking," sê dr. Taubenberger. In die meeste gevalle blyk dit dat die oorheersende siekte ten tyde van die dood bakteriese longontsteking was. Daar was ook bewyse dat die virus die selle langs die brongiale buise vernietig het, insluitend selle met beskermende haaragtige uitsteeksels, of silie. Hierdie verlies het ander soorte selle deur die hele respiratoriese kanaal - insluitend selle diep in die longe - kwesbaar gemaak vir aanvalle deur bakterieë wat oor die nuutgeskepte pad van die neus en keel af migreer.

In 'n poging om alle wetenskaplike publikasies oor die patologie en bakteriologie van die grieppandemie van 1918-1919 te bekom, het dr. Taubenberger en mede-outeur NIAID, David Morens, MD, bibliografiebronne gesoek na artikels in enige taal. Hulle het ook wetenskaplike en mediese tydskrifte wat in Engels, Frans en Duits gepubliseer is, nagegaan en alle artikels gevind oor die lykskouings wat op slagoffers van griep gedoen is. Uit 'n poel van meer as 2000 publikasies wat tussen 1919 en 1929 verskyn het, het die navorsers 118 belangrike lykskouingsreeksverslae geïdentifiseer. In totaal verteenwoordig die lykskouingsreeks wat hulle hersien het 8 398 individuele lykskouings wat in 15 lande uitgevoer is.

Die gepubliseerde verslae "het sekondêre bakteriële longontsteking duidelik en konsekwent by die meeste griepsterftes veroorsaak," sê dr Morens. Hy voeg by dat patoloë van die tyd byna eenparig was in die oortuiging dat sterftes nie direk deur die destyds geïdentifiseerde griepvirus veroorsaak is nie, maar eerder as gevolg van ernstige sekondêre longontsteking wat deur verskillende bakterieë veroorsaak is. Afwesig van die sekondêre bakteriële infeksies, het baie pasiënte moontlik oorleef, het kenners destyds geglo. Die beskikbaarheid van antibiotika tydens die ander grieppandemies van die 20ste eeu, spesifiek dié van 1957 en 1968, was waarskynlik 'n belangrike faktor in die laer aantal wêreldwye sterftes tydens die uitbrake, sê dr. Morens.

Die oorsaak en tydsberekening van die volgende grieppandemie kan nie met sekerheid voorspel word nie, erken die skrywers, en ook nie die virulensie van die pandemiese griepvirusstam nie. Dit is egter moontlik dat - soos in 1918 - 'n soortgelyke virusskade gevolg deur bakteriese inval kan ontvou, sê die skrywers. Voorbereidings vir die diagnose, behandeling en voorkoming van bakteriële longontsteking behoort een van die hoogste prioriteite te wees in die beplanning van grieppandemie, skryf hulle. 'Ons word bemoedig deur die feit dat pandemiebeplanners sommige van hierdie aksies reeds oorweeg en implementeer,' sê dr Fauci.

Besoek http://www.PandemicFlu.gov vir eenmalige toegang tot inligting van die Amerikaanse regering oor voël- en pandemiese griep.

NIAID doen en ondersteun navorsing-by NIH, dwarsdeur die Verenigde State en wêreldwyd-om die oorsake van aansteeklike en immuun-gemedieerde siektes te bestudeer en om beter maniere te ontwikkel om hierdie siektes te voorkom, te diagnoseer en te behandel. Nuusberigte, inligtingsblaaie en ander NIAID-verwante materiaal is beskikbaar op die NIAID-webwerf by http://www.niaid.nih.gov.

Oor die National Institutes of Health (NIH): NIH, die land se mediese navorsingsagentskap, bevat 27 institute en sentrums en is 'n komponent van die Amerikaanse departement van gesondheid en menslike dienste. NIH is die primêre federale agentskap wat basiese, kliniese en translasionele mediese navorsing doen en ondersteun, en ondersoek die oorsake, behandelings en geneesmiddels vir algemene en seldsame siektes. Vir meer inligting oor NIH en sy programme, besoek www.nih.gov.

NIH & hellipTurning Discovery Into Health ®

Verwysing

DM Morens et al. Oorheersende rol van bakteriële longontsteking as oorsaak van dood by pandemiese griep: Implikasies vir die voorbereiding van pandemiese griep. Die Journal of Infectious Diseases DOI: 10.1086/591708 (2008).


Wat het die Spaanse griep veroorsaak?

Die uitbraak het in 1918, gedurende die laaste maande van die Eerste Wêreldoorlog, begin, en historici glo nou dat die konflik deels verantwoordelik was vir die verspreiding van die virus. Aan die Wesfront het soldate wat in beknopte, vuil en klam toestande gewoon het, siek geword. Dit was 'n direkte gevolg van verswakte immuunstelsels as gevolg van ondervoeding. Hulle siektes, wat bekend staan ​​as 'la grippe', was aansteeklik en het onder die geledere versprei. Binne ongeveer drie dae nadat hulle siek geword het, sou baie soldate beter begin voel, maar nie almal sou dit regkry nie.

Gedurende die somer van 1918, toe troepe met verlof begin terugkeer huis toe, het hulle die onopgemerkte virus saamgebring wat hulle siek gemaak het. Die virus het versprei oor stede, dorpe en dorpe in die soldate se tuislande. Baie van die besmette, soldate sowel as burgerlikes, het nie vinnig herstel nie. Die virus was die moeilikste vir jong volwassenes tussen die ouderdomme van 20 en 30 wat voorheen gesond was.

In 2014 het 'n nuwe teorie oor die oorsprong van die virus gesuggereer dat dit eers in China verskyn het, berig National Geographic. Voorheen onontdekte rekords het die griep gekoppel aan die vervoer van Chinese arbeiders, die Chinese Arbeidskorps, oor Kanada in 1917 en 1918. Die arbeiders was meestal plaaswerkers van afgeleë dele van die platteland van China, volgens Mark Humphries se boek "The Last Plague" ( Universiteit van Toronto Press, 2013). Hulle het ses dae in verseëlde treinhouers deurgebring terwyl hulle deur die land vervoer is voordat hulle na Frankryk gegaan het. Daar moes hulle loopgrawe grawe, treine aflaai, spore lê, paaie bou en beskadigde tenks herstel. In totaal is meer as 90 000 werkers na die Wesfront gemobiliseer.

Humphries verduidelik dat in 'n telling van 25 000 Chinese arbeiders in 1918 ongeveer 3000 hul Kanadese reis in mediese kwarantyn beëindig het. Vanweë rasse -stereotipes was hul siekte toe die skuld op 'Chinese luiheid' en het Kanadese dokters nie die werkers se simptome ernstig opgeneem nie. Teen die tyd dat die arbeiders vroeg in 1918 in Noord -Frankryk aankom, was baie siek, en honderde sterf gou.


Wat die pandemie bewerkstellig het

Die Spaanse griep het sy naam gekry deur 'n vreemde samevloeiing van oorlogsbeperkings. Die regerings van strydende lande wou nie hê dat vyandelike nasies moet weet dat hul magte verswak word deur die vinnig bewegende siekte nie, en hulle wou ook nie hê dat die moraal agteruitgaan nie.

Spanje was tydens die Eerste Wêreldoorlog neutraal en sy koerante was nie gesensor nie. Hulle het verhale oor die dodelike griep gepubliseer, en so het die 'Spaanse griep' 'n naam geword wat vasgesteek het. Dit word ook die 'Purple Death' genoem omdat lyers soms 'n skrikwekkende skaduwee van indigo het weens 'n gebrek aan suurstof in hul bloedstroom. Dit word ook die 'Chinese griep' en 'Russiese plaag' genoem.

In die VSA het kinders tou oorgeslaan na hierdie rympie: "Ek het 'n voëltjie gehad, sy naam was Enza, ek het die venster oopgemaak en Enza gevlieg."

Maskers was onbeskof. Die historikus Kenneth Davis het bestaan ​​uit kaasdoek en gaas, wat min of meer gelyk is aan die hou van 'n stukkie skermvenster in die gesig en hoop dat dit die bakterieë kan stop.

Daar was geen federale riglyne oor enigiets nie. "Daar was geen CDC nie. Daar was geen National Institutes of Health nie. Daar was geen departement van gesondheid en menslike dienste nie," het Davis gesê.

Die samelewing en gesinne het in duie gestort. Uit groot stede en landelike gebiede kom berigte oor mense wat honger ly "omdat niemand die moed gehad het om vir hulle kos te bring nie, selfs nie ander lede van hul eie familie nie," het die skrywer John Barry gesê.

Honderdduisende kinders word weeskinders toe hul ouers aan die aaklige griep sterf.

Gesinne was toe groter, en broers en susters was geskei en na familielede of weeshuise gestuur. Sommige sou hulle broers en susters dekades lank of ooit weer sien. Erger nog, sommige is vir aanneming ingedien en soos deurpryse uitgedeel, en niemand kon toesig hou oor hul welsyn nie, want sosiale regeringsinstansies het destyds nie bestaan ​​nie.

'Hulle het die kinders wat hul ouers verloor het, op 'n trein gesit en van depot na depot gegaan, en almal wat 'n kind wou aanneem, sou net opdaag,' het Barry gesê, 'en saam met hulle gegaan.'

'Dus, daar was 'n hele generasie Spaanse grese weeskinders.'

Die griep het in 1918 in drie golwe gewoed, met die laaste ebging rondom die somer van 1919. "Die eerste fase, die minste dodelike, ten minste in die Verenigde State, het van Maart tot in die lentetyd gegaan," het Davis gesê. "Maar toe keer die griepseisoen terug in September, Oktober. Nog 'n paar troepe aan die gang, en 'n ware ontploffing. En die tweede golf was die dodelikste" in Amerika.

Die laaste golf het gestrek vanaf die winter van 1919 tot die somermaande, toe sake begin afneem het.

Die oorlog eindig op 11 November 1918. Die oorlewendes en soldate van mdash, verpleegsters op die slagveld en dokters en mdash stap of hink terug in die daaglikse lewe, en meer as enigiets anders wou hulle eenvoudig voortgaan.

In 1920 voer "Warren G. Harding 'n veldtog vir president oor die idee om terug te keer na normaal, en dit was 'n wen -slagspreuk," het Davis gesê. 'Hy het ingekom as (die) Republikeinse president, en hy het gesê:' Ons gaan terug na normaal '.

Na bewering was 'n laat lyer van die virus Woodrow Wilson, wat in 1920 in Parys was om te help onderhandel oor die Verdrag van Versailles. Die Franse stad sukkel destyds met 'n groot aantal griepgevalle.

Wilson het ernstig siek geword. Hy het herstel, "maar baie mense wat hom geken het, insluitend die valet van die Withuis wat hom lank geken het, het gesê dat hy nooit dieselfde was nie," het Davis gesê.

Sy oordeel en redenasie is moontlik aangetas, in teenstelling met koronaviruslyers wat kla oor mis en breekende geestelike terugslae.

'Hy het 'n paar baie, baie belangrike punte toegegee en toegegee,' het Davis gesê oor Wilson se onderhandelinge, insluitend 'baie meer straf -aspekte van die vergelding wat aan Duitsland gegee is in terme van die vergoedings wat hulle sou moes betaal'.

Dit het op sy beurt 'beslis bygedra tot die opkoms van Hitler en die Nazi's', het die historikus gesê.

In Amerika, vanaf die Eerste Wêreldoorlog, het veranderinge op elke vlak van die samelewing ingesluit.

Sylyne het gestyg en sosiale mores het afgeneem. Vroue het in 1920 die stem gekry, en baie het openlik gerook in die openbaar, hul hare getik en 'flappers' geword. Sakeondernemings het 'n goeie oplewing gehad, net soos die gesprekke, ondanks die nuwe verbod op die vervaardiging en verspreiding van alkohol.

'Ons is geneig om nie aan die geskiedenis te dink in terme van siektes nie,' het Davis gesê. 'Dit was 'n belangrike deel van die geskiedenis waaroor ons nie altyd leer of daaroor praat nie.'

Mense wou net vergeet. Hulle wou terugkeer na hul lewens.

'Dit was regtig iets wat so verskriklik was dat niemand daaroor wou dink, praat of skryf nie,' het Davis gesê.

Elke kwartaal verdiep die bekroonde joernaliste by Inside Edition Digital in 'n spesifieke onderwerp, wat dieper gaan as wat daaglikse nuussiklusse u toelaat om die kwessie, 'n reeks artikels en video's oor 'n spesifieke onderwerp, te bring. Klik hier vir meer van The Issue 3, waar ons in generasieverandering duik.


HistoryLink.org

Die verkeerde naam "Spaanse griep" -pandemie het 'n hoogtepunt bereik aan die einde van 1918 en bly steeds die mees wydverspreide en dodelike uitbraak van siektes wat die mensdom wêreldwyd in die geskiedenis opgetel het. Klein mutasies in 'n griepvirus het 'n buitengewoon dodelike variant geskep wat gesonde jong volwassenes doodgemaak het, net soos meer kwesbare ouderdomsgroepe. Die plek van oorsprong van die patogeen word nog gedebatteer, maar die rol van die Eerste Wêreldoorlog in die vinnige verspreiding daarvan is onbetwis. Tog het Washington, ondanks 'n sterk militêre teenwoordigheid, beter gevaar as enige ander staat in die unie behalwe Oregon. Alhoewel die dodetal die hoogste was in die bevolkte stede in die staat, het die pandemie byna elke gemeenskap geraak. Pogings om die uitbraak te beheer was grootliks tevergeefs, en van einde September 1918 tot einde daardie jaar het dit byna 5 000 Washington -inwoners doodgemaak. Meer as die helfte van die slagoffers was tussen 20 en 49 jaar oud.

'N Antieke plaag

Griepvirusse het waarskynlik 6 000 tot 7 000 jaar gelede mense die eerste keer siek gemaak, wat ooreenstem met die vroeë makmaak van varke en beeste. Verhoogde mobiliteit van mense vergemaklik epidemies en pandemies wat groot gebiede kan beïnvloed. Tot die vroeë dertigerjare was griep deur die meeste wetenskaplikes beskou as 'n bakteriese eerder as 'n virussiekte. Trouens, beide was dikwels betrokke, diegene wat verswak is deur 'n griepvirus, is meer kwesbaar vir bakteriële longontsteking. Tydens griep se jaarlikse besoeke het dit egter gewoonlik net matige siektes veroorsaak. Maar nou en dan het iets anders en baie meer dodelik gekom.

Die eerste aangetekende pandemie wat waarskynlik deur 'n griepvirus veroorsaak is, kom in 1580 en verwoes 'n gebied wat strek van Klein -Asië tot so ver noord as vandag se huidige Nederland. Daar was daarna gereeld groot uitbrake, maar relatief min sterftes. 'N Dodeliker virus tref Europa en die Russiese ryk in 1781-1782, en in 1889 en 1890 sterf meer as 'n miljoen mense toe 'n dodelike variant uit China bars, versprei na Rusland en in Europa en na Noord-Amerika en Latyn kom. Amerika voordat dit in Japan uitspuit. Daarna kom die pandemie van 1918, verreweg die algemeenste en dodelikste, 'n sombere onderskeid wat tot vandag toe bestaan.

Amerikaans Samoa was die enigste georganiseerde samelewing op aarde wat die pandemie van 1918 heeltemal kon ontsnap, danksy 'n vroeë, streng en lang kwarantyn. In Wes -Samoa, skaars 50 myl ver, is 20 persent van die bevolking binne enkele maande dood. Griep het die aardbol omring van oos na wes en van die noorde van die poolcirkel tot by die suidpunt van Chili, wat samelewings en tientalle miljoene mense in die nasleep laat lê het.

Heeltemal 'n ander siekte

Voor 1918 was die gemiddelde sterftesyfer vir die meeste griep slegs ongeveer 'n tiende van 1 persent, of ongeveer een sterftesyfer vir elke 1,000 infeksies. Die griep van 1918 het meer as 2,5 persent van die geteisterdes doodgemaak, byna altyd binne enkele dae na die eerste simptome en dikwels binne enkele ure. Sommige het gesterf as gevolg van akute respiratoriese nood ('n direkte effek van die griepvirus) en ander het prooi geword van opportunistiese bakteriële longontsteking. En anders as bykans enige vorige bekende aansteeklike siekte, het hierdie virus volwassenes tussen 20 en 40 jaar veral erg getref.

Die Eerste Wêreldoorlog was in die laaste maande toe die ergste van die pandemie getref het. Ongeveer 53 500 Amerikaners het hul lewens in gevegte verloor en 'n byna gelyke getal is dood aan griep terwyl hulle in Europa dien. Die getal Amerikaners, militêr en burgerlik, wat deur die virus tuis vermoor is, is na raming meer as 650,000. Die mees konserwatiewe (en miskien die minste akkurate) skatting van die dodetal wêreldwyd is meer as 20 miljoen, en soveel as 100 miljoen kan gesterf het (baie regerings het min of geen akkurate rekords gehou nie, wat selfs growwe ramings baie problematies maak).

Amerikaanse griep?

Dit is onbekend waar die pandemie ontstaan ​​het. Dit word algemeen die 'Spaanse griep' genoem, waarskynlik omdat Spanje, wat nie aan die Eerste Wêreldoorlog deelgeneem het nie, vrylik siektes en sterftes as gevolg van die siekte aangemeld het, inligting wat deur die strydende nasies gesensor is. Die bevooroordeelde vermoede dat dodelike aansteeklike siektes spruit uit landelike varkstokke in Asië of die stomende oerwoude van Afrika suid van die Sahara, was waarskynlik nie waar in 1918 nie. 'N Ondersteunbare teorie beweer dat die' Spaanse 'griep sy oorsprong in Haskell County, Kansas, in Februarie, het. In 1918 word 'n plaaslike dokter oorweldig deur 'n aantal gevalle van 'n besonder virulente en dodelike siekte, in teenstelling met enigiets wat hy in lang jare van praktyk gesien het. Tydens die uitbraak het 'n plaaslike man met verlof van die weermag huis toe gekom en daarna teruggekeer na Camp Funston in die uitgestrekte Fort Riley -kompleks, 300 myl daarvandaan. Binne drie weke is meer as 1 100 soldate in die kamp met die griep in die hospitaal opgeneem en 28 het nie oorleef nie, 'n buitengewoon hoë sterftesyfer.

Begin April is beduidende uitbrake van 'n ligter griep aangemeld, onder meer in Detroit, waar tot 2000 werkers by die Ford -motorfabriek getref is. Die dodelike variant het Spanje einde Mei getref. Die raaisel bly vandag - dit is onseker waar die 'normale' griepvirus gemuteer het tot 'n doeltreffende moordenaar. Mededingende teorieë wissel van Kansas tot Noorweë tot die hawens van die Engelse kanaal tot die gewone verdagte, China. Dit is onwaarskynlik dat hierdie vraag ooit finaal opgelos kan word, en dit maak nie saak nie.

Een feit is onbetwis: Oorlog en siekte het hand aan hand gegaan. Gedurende die lente van 1918 het konvooie Amerikaanse troepe vervoer om in die Eerste Wêreldoorlog te veg en met gewonde, siek en gedemobiliseerde soldate terug te keer. Alhoewel die konflik blykbaar geen direkte verband met die oorsprong van die virus gehad het nie, het dit alles te doen gehad met die verspreiding daarvan.

Wenke van 'n komende rampspoed

Baie van die gevalle wat in die middelmaande van 1918 aangemeld is, was relatief sag en gelokaliseer, maar aan die einde van Augustus het die gebeure 'n skrikwekkende wending geneem toe die dodelike variant losgebars het:

'Dit het byna gelyktydig in drie groot dele van die Noord -Atlantiese Oseaan voorgekom: Freetown, Sierra Leone, waar plaaslike Wes -Afrikaners saamgevoeg is met Britse, Suid -Afrikaanse, Oos -Afrikaanse en Australiese soldate en matrose Brest, Frankryk, wat die belangrikste hawe was vir Geallieerde troepe en Boston, Massachusetts, een van Amerika se besigste aanvangshawens in Amerika en 'n belangrike kruispad vir militêre en burgerlike personeel van elke nasie wat betrokke was by die Geallieerde oorlogspoging. Massiewe troepebewegings en die ontwrigting van belangrike dele van die bevolking tydens die Eerste Wêreldoorlog belangrike rol in die oordrag van die siekte "(" Griep, "webwerf vir mediese ekologie).

In Washington lyk die eerste agt maande van 1918 soortgelyk aan die meeste jare, en koerante in die staat het blykbaar geen kennis geneem van die uitbrake van griep in Detroit en 'n paar ander Amerikaanse stede nie. Op 15 April is egter berig dat by die weermag se Camp Lewis suid van Tacoma "Longontsteking gedurende die week effens toegeneem het, die meeste gevalle volg griep, wat twee weke gelede op sy maksimum was" ("Civil Workers Fast Being Uitgeskakel . "). Einde Mei Die Seattle Times 'n kort diensverslag bevat waarin gesê word dat ''n geheimsinnige epidemie' 'ten minste 40 persent van die bevolking van Spanje siek gemaak het, en dat alhoewel die simptome' soos griep lyk '. Siekte. "). 'N Week later sê die koerant oor die Spaanse uitbraak: "Die vinnige verspreiding daarvan is slegs vergelykbaar met die groot plaag van 1889," 'n verwysing na die grieppandemie van byna 30 jaar tevore ("King Visited by Strange Illness"). In Junie was daar vreugdevolle berigte oor 'n griepepidemie onder vyandige Duitse soldate, maar vroeg in die maand het Camp Lewis slegs 39 gevalle aangemeld.

Dinge het vroeg in Julie meer onheilspellend gelyk. Op 9 Julie, Die Seattle Times berig dat die griep in Spanje 'oor ander dele van Europa' versprei het ('' 'n Puzzelende epidemie ''). Op 28 Julie het die koerant opgemerk dat Camp Lewis 327 gevalle van griep het, maar 'n week later het die getal tot onder 100 gedaal. Teen middel Augustus was daar gerusstellende berigte dat die aantal griepgevalle by die weermagbasis steeds verminder het , en geen aanduiding van spesiale besorgdheid nie. Selfs in September was die algemene gemoedstoestand vol vertroue. 'N Optimistiese kommentator was opgewonde: "Dit is 'n wonder, vanweë die volmaaktheid van ons mediese wetenskap, dat daar hierdie somer geen wydverspreide epidemie was met 'n ernstiger karakter as' griep ', soos die Spaanse griep en ander geallieerde koors genoem word nie" ("Swaar reën en modder.").

Namate die maand aanstap, het 'n toon van beskeie alarm by sommige rekeninge begin insluip. A Tye artikel op 22 September verwys na 'n 'ligte epidemie' by Camp Lewis, met 173 nuwe gevalle wat aangemeld is ('Camp Lewis Reports.'). Op dieselfde bladsy is melding gemaak van twee ernstige gevalle van griep wat in Bellingham aangemeld is. Tog, twee dae later, is daar mediese bronne in die koerant aangehaal wat sê: 'Daar was moontlik 'n Spanjaard met griep in Camp Lewis, maar hier is geen Spaanse griep nie' ('Say Camp Lewis'). .

Dit kon verby die begraafplaas gewees het, maar in werklikheid het niemand die tsunami wat besig was om te bou, verstaan ​​nie. Wat gebeur het, was nie op afstand onder die kennis van die helderste wetenskaplikes en dokters van die era nie. Die virus wat griep veroorsaak het, het gemuteer, en op 'n manier wat dit een van die dodelikste patogene kan maak wat die mensdom ooit geteister het. Toe dit Amerika ten volle tref, het dit met asemrowende spoed deur die hele land beweeg, om elke draai gehelp deur 'n oorlogsmobiliseerde weermag.

Versprei soos 'n veldbrand

Tussen September 1918 en die einde van die oorlog in November was tot 40 persent van die Amerikaanse weermag- en vlootpersoneel besmet met griep. Die verband tussen die weermag en die vinnige verspreiding van die pandemie was duidelik duidelik. Staatsgesondheidsamptenare was bewus van die gevaar. In die notule van 'n staatsraad van gesondheidsvergadering in Spokane op 28 September 1918 word opgemerk: "Die waarskynlikheid van 'n uitbraak van griep in die staat is breedvoerig bespreek en maniere en middele om die voorkoming daarvan te probeer oorweeg" (Twaalfde tweejaarlikse verslag, 6).

Dit blyk onvoorkombaar en in wese onbehandelbaar te wees. Slegs twee dae later, op 30 September, by die University of Washington Naval Training Station in Seattle se Portage Bay (die huidige plek van die universiteit se Health Sciences -kompleks), is meer as 650 gevalle van "ligte griep" aangemeld ("Navy Camp at" U '. "). In die eerste week van Oktober is meer as 100 gevalle van "ernstige griep" by Camp Lewis gedokumenteer. Gevalle is ook gevind by die Puget Sound Naval Shipyard in Bremerton, en op 4 Oktober is berig dat 14 vlootrekrute daar gesterf het en "tussen 200 en 400" burgerlike werkers by die vlootwerf siek geword het ("Bremerton Hit.") . Hierdie berigte was 'n voorbode van veel erger wat gekom het, aangesien die dodelike virus met ongelooflike spoed versprei het.

'N Gebrek aan data

Om verskeie redes is dit onmoontlik om die vordering van die pandemie in die staat op te spoor. In die eerste plek was griep nie 'n siekte wat by die staatsgesondheidsowerhede aangemeld moes word nie, ten minste nie tydens die mees virulente fase in die herfs van 1918 nie. Vrywillige beriggewing was uiters sporadies, soos gesien sal word. Sterftes het geen diagnose nodig gehad nie en is getrou opgeteken, maar die totale getalle van die besmette moet as growwe ramings beskou word, selfs as dit indrukwekkend spesifiek is.

Tweedens kom die griep in 1918 en vroeg in 1919 in drie verskillende golwe - 'n gewoonlik ligte vorm in die lente en somer van 1918, gevolg deur die dodelike spanning in die laaste maande van daardie jaar en eindig met 'n terugkeer van gewoonlik (maar nie altyd nie) ligter siekte in die vroeë maande van 1919, nie heeltemal afneem tot in 1920. Nie almal wat siek geword het, was besmet met die virulente "Spaanse" griep nie, sommige het 'n ligter vorm, wat nog dodelik kan wees vir baie jong en die bejaardes.

Om die owerheidsgesondheid van die gesondheid verder te frustreer, het die Spaanse griep beide regstreeks doodgemaak en slagoffers kwesbaar gelaat vir sekondêre infeksies met bakteriële longontsteking, wat dikwels dodelik was selfs in die afwesigheid van griep, veral by bejaardes of siekes. Dit het die oorsaaklikheidsbeeld verward gemaak. Maar omdat die Spaanse griep so verstommend aansteeklik was en longontsteking so gereeld gevind is tydens lykskouings van griepslagoffers, het die federale sensusburo besluit om 'n enkele kategorie in sy sterftestatistieke vir 1918 te gebruik: "sterftes as gevolg van griep en longontsteking (alle vorme)" (Sterftestatistiek, 1918). Net so frustrerend as vir epidemioloë en lewensversekeringsaktuarisse, is alle statistiese studies oor die gevolge van die pandemie van 1918 deurspek met onsekerheid en benaderings.

Wat die rekord toon

Washington was een van 30 'registrasiestate' wat volgens die Amerikaanse sensusburo in 1918 redelik betroubare rekordhouding gehad het, maar die epidemioloog van die staat, in 'n tweejaarlikse verslag van die Raad van Gesondheid van Januarie 1919 aan goewerneur Ernest Lister (1870-1919), beklemtoon die ongekende aard van die pandemie en die moeilikheid om akkurate inligting in te win:

"Hierdie pandemie het in die eerste week van Oktober in Washington verskyn. In die geskiedenis van die State Board of Health het die staat nog nie so 'n ramp getref nie, en het daar nog nooit so 'n ernstige noodgeval ontstaan ​​nie. In die vyf jaar 1913-1917, insluitend vanaf die vyf mees algemene aansteeklike siektes. daar was 1768 sterftes. Van griep alleen moes ons tot dusver meer as 2000 sterftes opduik en die einde is nog nie. Die tol sal waarskynlik dubbel of drievoudig wees 1768.

"Stadsgesondheidsbeamptes, behalwe in Seattle, Tacoma, Spokane en Yakima, is deeltydse mans. Hulle salaris is dikwels niks of vyf dollar per maand nie. Hulle word deur hul burgemeesters aangestel en verander gereeld. Hulle is nie van ons nie en doen voel nie asof hulle baie verantwoordelikheid teenoor ons het nie. Hulle werk betaal min en hul beleid is om soveel te doen as wat die betaling regverdig "(Twaalfde tweejaarlikse verslag, 34-35).

Die verslag is opgestel in Desember 1918, toe die volle omvang van die ramp onbekend was. Die volgende tweejaarlikse verslag van die gesondheidsraad is eers in Januarie 1921 uitgereik en was byna stil oor die pandemie van 1918. Dit lyk asof daar geen staat of federale samestelling van infeksiesyfers of sterftes per land is nie, veel minder vir individuele gemeenskappe, hoewel daar wel sensusdata bestaan ​​vir Washington se twee grootste stede, Seattle en Spokane, en Yakima se ervaring is relatief goed gedokumenteer.

In sy Sterftestatistiek 1918 die Amerikaanse Sensusburo het die staat se totale griepsterftes in 1918 vergelyk met dié van 1915, in teenstelling met die eerste agt maande van elke jaar met die laaste vier. Tussen Januarie en Augustus 1915 sterf 605 inwoners van Washington in die eerste agt maande van 1918 aan griep en longontsteking, 838 Washingtoniërs sterf, 'n aansienlike maar nie skokkende toename nie.

In die laaste vier maande van 1915 het slegs 381 mense in Washington aan die griep beswyk, maar in die laaste vier maande van 1918 het die pandemie 4,041 in die staat doodgemaak, 10,6 keer die telling van 1915 vir dieselfde tydperk. Die pessimisme van die staatsepidemioloog oor die finale tol was redelik akkuraat.

Ander feite uit die sterftetabelle toon die ongekende aard van die Spaanse griep aan. Miskien die mees verrassende, effens meer as die helfte, of 2 461 van die 4,879 griepsterftes in Washington in die kalenderjaar 1918, was mans en vroue tussen die ouderdomme van 20 en 39 jaar, die demografiese groep wat normaalweg die hoogste siekteoorleefbaarheid geniet het. Dieselfde growwe verhoudings geld in die twee grootste stede van die staat. In Seattle het 708 van die 1 441 griepsterftes wat tussen 12 Oktober 1918 en 15 Maart 1919 aangeteken is, in daardie ouderdomsgroep geval, terwyl die telling in Spokane 252 van die 428 griepsterftes was. These numbers alone illustrate just how unique this pandemic was in comparison to any other disease outbreaks for which records exist. This mystery has never been fully resolved, but the leading theory is that the 1918 virus triggered catastrophic immune reactions in young adults with robust immune systems.

Comparative numbers were not calculated for Yakima, but roughly one-third of the population, or about 6,000 people, were infected there. Of these, 120 died -- 32 percent of the city's total 1918 death toll from all causes. So contagious was the disease that Yakima's only hospital, St. Elizabeth, run by the Sisters of Providence, for a time refused to admit influenza patients.

There is only one statistic in the 1918 mortality tables from which some comfort may be taken. Of the 30 registration states relied upon by the Census Bureau, with the single exception of Oregon, Washington by a significant margin had the lowest number of influenza/pneumonia deaths per 1,000 residents. Nevertheless, 4.1 of every 1,000 Washingtonians were killed by influenza/pneumonia in 1918 (more than five times normal) and 1.9 of every 1,000 in 1919 (more than twice normal). In contrast, the state's mortality rate from those causes in each of the three preceding years was less than one per 1,000.

Doing Their Best

The health board's Twelfth Biennial Report documented both a realistic apprehension of the danger Spanish influenza presented and a recognition of the futility of efforts to prevent it. It recounted the efforts of Dr. Thomas D. Tuttle, the state's health commissioner and the report's lead author, to get advice from the federal government:

"This epidemic was very prevalent in the Eastern states during the month of September, and, realizing that in all human probability it would rapidly spread over the entire country, your commissioner of health took up with the United States Public Health Service the question of the advisability of quarantining individual cases" (Twelfth Biennial Report, 22-23).

Specifically, the board reported, Tuttle sent a telegram to U.S. Surgeon General Rupert Blue asking "Intrastate quarantine Spanish influenza under consideration. What period of quarantine if any do you recommend?" and Blue relied "Service does not recommend quarantine against influenza" (Twelfth Biennial Report, 22-23).

In the report Tuttle provided the health board's opinion on how the Spanish flu came to Washington. It is but one theory among several, but as credible as any:

"The epidemic struck our state in the early part of October. The immediate introduction of the disease was through a shipment from Pennsylvania to the United States Naval Training Station at Bremerton of about 1500 men, a large percentage of whom were afflicted with influenza when they reached their destination. From this location the disease spread widely [but] many outbreaks were not directly traceable to the infection at or near Seattle" (Twelfth Biennial Report, 23).

Tuttle's account of a Chicago meeting of state health authorities could not conceal a tone of desperation:

"The outstanding feature of the discussion of the subject at this conference was the evidence that whatever efforts were made the spread of the disease was only retarded and not prevented. As one health officer very aptly expressed the situation: 'One can avoid contracting the disease if he will go into a hole and stay there, but the question is how long he would he have to stay there? The indications are that it would be at least for a year or longer'" (Twelfth Biennial Report, 23).

Desperate Measures, Mostly Futile

Despite its early concerns, the Washington State Board of Health did not impose statewide measures to combat the pandemic until it was well under way, probably because it had very limited resources and little or no control over local health authorities. The only preventive regulation of statewide application that the board issued came on November 3, 1918, when it required that surgical masks of a specified size and thickness "entirely covering the nose and mouth" be worn in virtually all public places where people came into close contact with one another the order also required that the proprietors of stores, restaurants, and cafes "keep their doors open and their places well ventilated" and that one-third of the windows in streetcars be opened when in use by the public ("Special Order and Regulation . ").

Vancouver in Clark County was one of the first cities in the state to aggressively address the pandemic. On October 7, 1918, acting on a report from the chief health officer, the city council ordered that "all places of public gathering, such as schools, churches, dances etc." be closed (Vancouver City Council minutes). Two days later the town council of Monroe in Snohomish County approved a similar measure, as did Yakima, which later joined with Yakima County to lease a building owned by St. Michael's Parish "for the purpose of establishing same as an Isolation Hospital" (Yakima City Commission minutes, October 21). On October 31 the ban on gatherings in Yakima was widened even further to include "all places where any kind of business is transacted . with the exception of drug stores, meat markets, restaurants, eating places, hotels and fruit ware-houses," the last an apparent concession to the town's leading industry (Yakima City Commission Minutes, October 31).

Similar bans on public assembly were imposed in counties, cities, and towns across the state. A small sample would include Seattle (October 6) Spokane (October 8) Pullman (October 10) Anacortes in Skagit County (October 15) Ferry County in Northeast Washington (November 17) tiny Wilson Creek in Grant County, where all children under age 16 were ordered confined to their homes (December 7) and Chelan, although it exempted schools (December 10). No corner of the state was spared, nor did the ordeal end with the new year. The Cowlitz County Council did not even impose similar restrictions until January 16, 1919, and White Salmon to the east was at that time still under siege.

These and similar measures probably helped to limit the spread to some extent, but perhaps the most telling reason for the eventual ebbing of the pandemic was that it simply ran out of vulnerable victims. In this regard it is important to remember that most people did nie become infected, despite nearly universal exposure, nor did it kill but a fraction of those it did infect.

What Was It? Where Did It Go?

In the 1990s researchers, using archived autopsy samples from 1918, mapped the virus's genome and determined it to be Type A, the most common, which can infect both humans and some animals. More specifically, the investigation revealed that the virus was a strain of Type A known as H1N1. The "H" represents a protein molecule on the surface of a virus that is the usual target for the immune system. When random mutations alter that molecule, the virus can become virtually invisible to the body's defenses. As researchers explained in 2006, "Recently published . analyses suggest that the genes encoding surface proteins of the 1918 virus were derived from an avianlike influenza virus shortly before the start of the pandemic and that the precursor virus had not circulated widely in humans or swine in the few decades before" (Taubenberger and Morens, 16). Because it had not circulated widely, humanity had developed no "herd immunity" to it. This explains its rapid spread but not its lethality, which remains a mystery.

As to where it went, the answer is that it went nowhere. Almost all cases of type A influenza since 1918 have been caused by less-dangerous descendants of that lethal virus. Viruses do not have intentions, only random mutations. Some mutations will enable them to sicken birds, pigs, people, or other animals. Some will make them unusually lethal, others will render them totally harmless to humans. But inevitably a strain will emerge that is as infectious and deadly as the 1918 variety. Viral mutation is ongoing, endless, and unpredictable. In any new flu pandemic the toll will likely be lower due to advances in immunology and other countermeasures, but as with death itself, the question is not whether it will come, but rather when.

Announcement closing public places during flu pandemic, The Pullman Herald, October 11, 1918

Policemen wearing gauze masks during influenza epidemic, Seattle, December 1918

Courtesy National Archives (Record No. 165-WW-269B-25)

Stewart and Holmes employees wearing masks, 3rd Avenue, Seattle, 1918

Photo by Max Loudon, Courtesy UW Special Collections (UW1538)

Front page, Die Seattle Times, October 5, 1918

Streetcar conductor blocking entry of unmasked man during flu pandemic, Seattle, 1918

Courtesy National Archives (Record No. 165-WW-269B-11)

Masked elevator attendant during flu pandemic, Seattle, 1918


Historical accounts detail wave of flu deaths in Oklahoma during 1918 pandemic

Those chilling first-person accounts don’t describe some modern-day disease outbreak occurring half a world away. Instead, they’re words that Oklahomans in the last century used to describe what is believed to be the deadliest epidemic in human history: the 1918 flu pandemic.

The video-taped interviews, recorded in the 1980s and included in the Oklahoma History Center archives, offer chilling descriptions of those dark days: whole towns sickened, healthy people dead within hours, mothers and children dying on the same day.

This year, with 82 fatalities reported since September, Oklahoma has recorded the largest number of annual flu deaths since the state began tracking the number in 2009. But those numbers pale in comparison to the tide of death that swept across Oklahoma and much of the world in 1918 when experts estimate as many as 100 million perished from the virus, 675,000 of them in the United States.

According to some experts, the 1918 pandemic may have gotten its start just 40 miles north of the Kansas-Oklahoma line.

“There are other theories about other sites,” said John M. Barry, a New Orleans-based author of a 2004 book on the 1918 outbreak. “I think the evidence for Haskell is probably roughly as good as it is for any other site, but we’ll probably never know.”

In January and February, 1918, an eruption of influenza in Haskell County, Kan., struck down some of the strongest, healthiest people “as if they had been shot,” Barry wrote in “The Great Influenza: The Epic Story of the Deadliest Pandemic in History.”

At a time when public health agencies had yet to begin tracking such outbreaks, the Kansas cases were severe enough to prompt a local doctor to warn national public health officials about the virulent strain.

From there, the disease is believed to have spread when Haskell County men reported to an Army camp at Fort Riley, Kansas. That spring, at least 1,100 of the fort’s 56,000 troops required hospitalization. Those soldiers then fanned out to Army posts throughout the U.S. and then to France, transporting the flu to the trenches of World War I. In Europe, the outbreak received prominent coverage from Spanish media outlets while those in Germany, France and Britain avoided such coverage, fearing reports would hurt morale, Barry said. As a result, the outbreak got a nickname: The Spanish flu.

In August 1918, the epidemic hit America’s East Coast like a bomb. At Camp Devens, in Boston, 1,543 soldiers reported ill with influenza in a single day. In a letter to a colleague, a doctor at the post described how the flu turned into the most vicious type of pneumonia he had ever seen the faces and bodies of dying victims turned blue from the lack of oxygen, sparking rumors that the Black Death, a terrifying plague from the Middle Ages, had returned. Healthy men dropped dead within a matter of hours, hundreds in a day, some of them bleeding from the eyes.

Sooner state ravaged

In Oklahoma, state officials reported the first cases of influenza in Tulsa and Clinton on Sept. 26 by Oct. 4, 1,249 cases had been reported in 24 counties. After that, the spread became so difficult to track that officials made reports in generalities, according to a history of the epidemic on the U.S. Department of Health and Human Services’ website flu.gov.

“People died like flies,” Jim W. Smith, recalled in one of the archived interviews. Smith, of Washington, OK, who would have been 22 in the fall of 1918 and going to school in Durant for his teaching certificate, said most people died when, while on the mend, they went back to work and relapsed.

Ralph Norman was 21 when he fell ill while at a military training camp. In an archived interview, the Woodward resident remembered one hospital room filled with the corpses of soldiers who had died from the flu.

Fern Behrendt recalled the flu’s beginnings in the Oklahoma panhandle. Then 19, she remembered a family who lived about six miles north of Boise City being the first to contract the virus and then watching it quickly spread.

“Quite a few people died,” Behrendt told her interviewers.

Behrendt said she helped a local family until she caught the flu. After she recovered, she continued to help area families by doing chores while they were sick.

C.L. Alley said he was the first of 600 Woodward men drafted for World War I but was sent home because he was a farmer and rancher and received a deferment. Soon after, “the whole neighborhood came down with the flu,” he reported. The only doctor’s orders, he said, were “just go to bed and rest.”

On Sunday, Oct. 13, 1918, church bells stayed silent in Oklahoma City as every house of worship canceled services “due to the city commissioners’ drastic order closing all schools, churches and other public places in an effort to stay the spread of the Spanish influenza. . ”

Seeking a cure

Newspaper ads from that period hawked quack cures, everything from whiskey to mouth gargle Vicks reported a shortage of VapoRub and those in rural areas turned to home remedies, like rock candy in whiskey and cloverleaf salve.

The flu outbreak caused a run on whiskey, which jumped to $18 a quart in Oklahoma City, according to an Oct. 15, 1918, article in The Daily Oklahoman.

But the epidemic also brought out the best in some people.

A Feb. 8, 1919, story described how a destitute 35-year-old father arrived in Enid with thinly clad and barefoot children, two boys, 8 and 6, and a 4-year-old girl. The children’s mother had died from the flu and the father had lost his job while battling his own sickness. He traveled by train from Oklahoma City to Enid in search of work. En route, passengers collected $15 for the family and local residents purchased clothes for the children and helped get the man a job.

Avoiding another pandemic

Ultimately, the Spanish flu is estimated to have killed at least 7,500 people in Oklahoma and sickened an estimated 100,000 more.

Today, public officials aren’t sitting around waiting for the next pandemic.

The World Health Organization established a formal monitoring system for flu viruses in 1948, with scientists around the world collaborating to track virus mutations and adjust each year’s vaccine.

Health experts say that in addition to getting a flu shot, two of the best ways to keep from getting or spreading the flu are to wash your hands frequently and cover your mouth with your inner elbow when you cough.

Could a pandemic like this one resurface?

“It’s inevitable,” Barry said.

“Any infectious disease expert will tell you (their) biggest nightmare is another serious influenza pandemic.”

There are other theories about other sites. I think the evidence for Haskell is probably roughly as good as it is for any other site, but we’ll probably never know.”

Author John M. Barry,

Related Photos

Patients and workers fill an emergency hospital at Camp Funston, Kan., during the 1918 influenza epidemic. PHOTO PROVIDED BY NATIONAL MUSEUM OF HEALTH AND MEDICINE COURTESY OF THE NATIONAL MUSEUM

Patients and workers fill an emergency hospital at Camp Funston, Kan., during the 1918 influenza epidemic. PHOTO PROVIDED BY NATIONAL MUSEUM OF HEALTH AND MEDICINE COURTESY OF THE NATIONAL MUSEUM

The forgotten agony - the Spanish Flu pandemic of 1918-19

The World Health Organisation has recently released a plan designed to meet ‘the greatest threat to global public health.’ The report describes the threat as neither predictable nor preventable, and not a question of if it will strike the world, but when. The Global Influenza Strategy 2019-2030 aims to enable the world to better coordinate and respond to the threat posed by a potential influenza pandemic. In our increasingly globalised and interconnected world the threats posed by such pandemics are taken extremely seriously. This is due, in part, to the experiences of a previous pandemic, when global movements saw a virus emerge that would devastate a worldwide population already scarred by the carnage of war.

Although a number of pandemics have occurred in previous decades, the most deadly was the Spanish Flu pandemic of 1918-1919. The Spanish Flu has been described by the author Laura Spinney as ‘the greatest tidal wave of death since the Black Death, perhaps in the whole of human history.’ This pandemic is estimated to have caused the deaths of between 50-100 million people and infected one-third of the human population, around 500 million people. The flu killed far more than either the First or Second World Wars, and may even have killed more than the death tolls from both conflicts combined. The flu forced fundamental changes to public heath care systems across the globe and its severity and impact is still felt today.

The flu that most people are aware of is a seasonal virus that circulates across the globe in the colder months. Although the flu virus can effect humans, it is also prevalent in birds and mammals. Sometime in late 1917 or early 1918 a strain of avian flu managed to make the transition from birds to humans. Historians still debate the exact location of ‘patient zero,’ the very first human to become infected with this deadly new strain. Some scientists such as British virologist Professor John Oxford argue that the outbreak began in a hospital camp in Etaples, France, whilst others suggest that it began in a US Army camp in Kansas.

"We are facing a health threat unlike any other in our lifetimes."

A message from @antonioguterres, Secretary-General of @UN. #CoronavirusOutbreak pic.twitter.com/Zhs8o0iLUP

— HISTORY UK (@HISTORYUK) March 16, 2020

Spain was immune from the censorship that limited the wartime nations press. When the Spanish King was struck down many newspapers were finally able to report on the outbreak that was sweeping across the world. These press reports then led to a mistaken belief that the outbreak had started in Spain.

The unusual circumstances of 1918 helped the virus to travel further and faster than in any previous event in human history. The First World War resulted in the largest global migration of humans yet seen. This enabled the virus to spread, on troopships and transports, to every corner of the globe. Furthermore, the large concentrations of people, especially in the military, enabled the virus to infect individuals with lightning speed.

Although the study of bacteria was well known, the presence of viruses had been postulated but never proven because no equipment then existed to observe something so small. This meant that when the outbreak occurred there was no way of studying the virus effectively or developing a cure.

The Spanish Flu instead appeared to target young men and women between the ages of 18-35

A further terrifying feature of the outbreak that was apparent from its onset was the main age group of its victims. Seasonal influenza normally targets children under the age of 4 or elderly grandparents over the age of 65. The Spanish Flu instead appeared to target young men and women between the ages of 18-35. This age group normally has the strongest and healthiest immune systems, able to fight off any illnesses. However the Spanish Flu turned its victims own immune systems against them. The virus would trigger a Cytokine Storm, an autoimmune response whereby the victims immune system goes into overdrive, attacking and causing significant damage to lung tissue. This damage would cause the victims to turn blue as their bodies battled for oxygen. Victims would then eventually drown as their lungs filled with fluid.

The first wave of the outbreak in early 1918 was mild by comparison, but by August a second far deadlier strain was sweeping the world.

The devastating impact of the virus is illustrated in the ways it affected local communities. The first reports of the virus hitting the town of Crewe in the North West of England occurs in June of 1918. It reportedly laid low many of its residents, especially in its large railway works which would prove the perfect breeding ground for the virus. By November the virus had claimed 60 lives in just a 10 day period and resulted in 115 internments in Crewe’s cemetery, the highest in any month since the cemetery opened. In November 1918 of the 38 men killed on active service 18 are confirmed to have died of an influenza related illness.

The influenza virus is a parasite that can only live in an infected host. The most successful strain would be the one in which the host stayed alive, enabling the virus to be passed on. If the virus killed the host its chances of being passed on become limited. This helps to explain the spikes in death rates, and why the virus came and went so quickly. The virus became a victim of its own success, its deadly nature resulted in victims failing to pass on more deadly strains, which eventually led to the virus appearing to seemingly vanish after the end of the third wave in 1919.

The virus caused worldwide devastation to communities ravaged by the effects of war. The world of 1920 wanted to forget the terrible experiences of the war years, and so the Spanish Flu was confined to memory. In the years that have followed however, scientists have studied its devastating effects, using the outbreak as a model in how to cope with future pandemics. The virus is still around today, although in a less deadly form than when ‘the Spanish Lady’ first struck one hundred years ago.


Are Covid Fatalities Comparable with the 1918 Spanish Flu?

On April 23, 2021 The New York Times published an article titled “How Covid Upended a Century of Patterns in U.S. Deaths.” The article lays out some data regarding the unprecedented uptick in the US death rate that occured in 2020.

As shown in the graph provided by the New York Times, US death rates have been steadily declining over the past century, likely due to advances in technology and living standards. Last year certainly signaled a noticeable break from this trend with a sizable increase in deaths, but not nearly the same as the 1918 Flu which is a universal benchmark for a killer influenza virus.

This graph provided by the New York Times indicates the spike in excess deaths in 2020, which is the number of deaths that have occured exceeding the predictions of standard death trends. This is of course all important information. Last year was certainly a horrific year with the outbreak of Covid-19, the lockdowns, and all the chaos that followed. It was a year of death and despair which should not be taken lightly.

Important Discussion: Deaths and Victims

It is common to invoke comparisons with the 1918 Flu Pandemic, as that was an extremely devastating virus that rocked the world. The article makes multiple references to the 1918 pandemic but there are a couple that raise interesting questions for further investigation. The first point is as follows,

“Combined with deaths in the first few months of this year, Covid-19 has now claimed more than half a million lives in the United States. The total number of Covid-19 deaths so far is on track to surpass the toll of the 1918 pandemic, which killed an estimated 675,000 nationwide.”

Comparing the death counts between the 1918 Flu and Covid-19 without adjusting for population growth is extremely misleading. In 1918 the population of the United States was roughly 103 million, while near the end of 2020 it stood at roughly 330 million. According to CDC statistics compiled by a study in JAMA Covid-19 killed 345,000 people in 2020 and now stands at around half a million as stated by the New York Times. Adjusted for the population growth of over 200 million people and holding the death rates constant, the 1918 Flu would have killed over 2 million people if it occured today, which is more than four times greater than Covid-19.

Furthermore, the two diseases are vastly different in terms of who is vulnerable. Covid-19’s severe outcomes almost exclusively affect the elderly and the immunocompromised, particularly those over the age of 65, which is also approaching the life expectancy of a human. Furthermore 94 percent of Covid deaths occurred with preexisting conditions. It poses virtually no risk to children, minimal risk to young adults, and only seems to kill more than 1 percent of victims with those over the age of 65.

On the other hand the Spanish Flu was devastating to virtually all age groups and did not discriminate between the healthy and the unwell. The CDC writes the following about the 1918 Flu:

“Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.”

It is clear that the comparison is flawed between the 1918 Flu and Covid-19, as the former was a devastating killer virus whereas the latter only poses a threat to vulnerable populations.

Too Much Statistical Noise

It is certainly worth investigating the noted increase in excess deaths in 2020 as that is obviously a problem. However, the article seems to suggest that Covid-19 was the main causal factor driving increases in death. Although that is certainly a reasonable intuition given that it is a novel virus, clearly there is far more at play.

The main issue to point out is that there were two health crises, not one. Covid-19 is certainly one but we cannot simply ignore the absolutely devastating and unprecedented use of lockdown policies that drastically upended all of society in a way that a virus could never accomplish.

The effects of lockdowns have been thoroughly studied by AIER and in a series of articles I noted just some of the damage to the economy, young people, and the normal functioning of society. All these disruptions led to adverse outcomes whether it be mental health issues, decline in living standards, or even disrupted healthcare procedures. In a press release the CDC noted that in May 2020, it recorded the highest number of drug overdoses ever recorded in a 12-month period.

A study in JAMA notes that although there was a substantial increase in overall deaths in 2020, Covid-19 was only one part of the problem, assuming all Covid deaths are directly attributable to Covid and not a comorbidity.

Some statistics of note are an increase in deaths due to heart disease, unintentional injuries, stroke, and diabetes. Although more investigation would be needed to understand how all of this comes together, it wouldn’t be absurd to believe that lockdown policies led to an increase in deaths due to their many disruptions to normal societal functions.

To cite one example of many, the Mackinac Center Legal Foundation recounts on one of its clients by writing,

“One of the affected medical practices, Grand Health Partners, operates in the Grand Rapids area. It performs endoscopies and other elective surgeries, many of which were deemed nonessential by executive order. Due to the shutdown, many of their patients were not able to receive treatment and have suffered because of it.”

Alongside exploring and cutting through the statistical noise posed by increases in death plausibly related to lockdowns, there still needs to be a discussion on quantifying the Covid-19 death count. Genevieve Briand, an economist at John Hopkins University, was subject to a massive degree of controversy for putting out a flawed but important lecture – later expanded into a research paper – that pointed out among other things that Covid-19 deaths may be inappropriately reclassified as deaths from other leading causes.

This is especially worthy of discussion given that the overwhelming majority of Covid deaths occur with comorbidities amongst eldery populations often nearing or exceeding life expectancy.

Key Takeaway

The data is clear 2020 was a horrific year full of death and despair. The New York Times’ article certainly does a great job at starting a conversation about this topic. However, its comparisons of Covid-19 and the 1918 Flu raises more questions than answers. Furthermore its presentation of data regarding increases in deaths requires more context.

Upon further investigation, it is clear that Covid-19 claimed many lives. However, it is also clear that there is a substantial presence of statistical noise from comorbidities and increases in death from other causes. This raises many questions not just about the collateral damage of our policy response, but also about whether we are even operating with the appropriate information to be making such decisions with people’s lives in the first place.


Vaccine Development Across the United States

At the Naval Hospital on League Island, Pennsylvania (the Philadelphia Naval Shipyard), physicians described their approach to a vaccine: “After the nature of a drowning person grasping at a straw, a stock influenza vaccine was used as a preventive in fifty individual cases and as a curative agent in fifty other uncomplicated cases” (Dever 1919). They made the vaccine made from B. influenzae and strains of pneumococcus, streptococcus, staphylococcus, and Micrococcus catarrhalis (nou Moraxella catarrhalis). Each dose contained between 100,000,000 and 200,000,000 bacteria per cubic centimeter, in a four-dose regimen. The investigators reported that no vaccinated individuals (who were hospital workers) became sick, but also noted that strict preventive measures were taken, such as the use of masks, gloves, and so on. In a group of ill patients treated therapeutically with the vaccine, none developed pneumonia but one developed pleurisy (infection of the lining of the lungs). They noted, “The course of the disease [in those treated therapeutically]…was definitely shortened, and prostration seemed less severe. The patients apparently not benefitted were those admitted from four to seven days after the onset of their illness. These were out of all proportion to the number of pneumonias that developed and the severity of the infection of the control cases. The effects were always more striking, the earlier the vaccine was administered.” Finally, they concluded that, “The number of patients treated with vaccines and the number immunized with it is entirely too small to allow of any certain deductions but so far as no untoward results accompany their use, it would seem unquestionably safe and even advisable to recommend their employment.”

Another group of investigators described the use of vaccines at the Naval Training Station in San Francisco. They relate that Spanish influenza did not reach San Francisco until October 1, 1918, and that that staff at the training station therefore had time to prepare preventive measures (Minaker 1919). Isolation was easy, due to the location of the base on Alameda Island, reachable only by boat from San Francisco and Oakland. Naval Yard personnel were required to use an antiseptic throat spray daily. Beyond these measures, the authors noted that “steps were taken to produce a prophylactic vaccine,” even though there was a “great diversity of opinion as to the exciting cause” of the pandemic. In general pneumococcus and streptococcus were seen as the cause of the most severe complications. Additionally, and amid dissent, they decided to obtain a culture of B. influenzae from a fatal case at the Rockefeller Institute to include in the vaccine. In all, the vaccine contained B. influenzae, 5 billion bacteria pneumococcus Types I and II, 3 billion each pneumococcus Type III, 1 billion and Streptococcus hemolyticus (S. pyogenes), 100 million.

Guinea pigs were first injected with the vaccine to assess toxicity, and then five lab worker volunteers were inoculated. Lab tests determined that their white cell count increased and their sera agglutinated B. influenzae (meaning that they had antibodies in their blood that reacted to the bacteria). Side effects from the injection included local swelling and pain but no abscesses. Given permission to proceed, more vaccine was prepared and 11,179 military and civilians were inoculated, including some at Mare Island (Vallejo, CA) and San Pedro as well as San Francisco civilians associated with the Naval Training station. In most experimental groups, the rate of influenza cases was lower than in the uninoculated groups (though no information is given on how the statistics for the uninoculated groups were gathered, nor is there information on how a case was defined). Moreover, people who were inoculated received the injections about three weeks after influenza appeared in California, so it’s impossible to tell whether they had already been exposed and infected. The percent of influenza cases in control groups ranged from 1.5% to 33.8% (the latter being nurses in San Francisco hospitals), whereas between 1.4% and 3.5% (the latter being hospital corpsmen on duty in an influenza ward) of those in the inoculation group became ill with influenza.

Another use of vaccine was documented in Washington State at the Puget Sound Navy Yard (Ely 1919). Investigators claim that influenza invaded the Navy Yard when a group of sailors arrived from Philadelphia (it’s unclear exactly when they arrived, but the paper states that “the period of observation was from September 17 to October 18, 1918”). In all, 4,212 people were vaccinated with a streptococcal vaccine. The investigators reported that the influenza attack rate in the vaccinated ranged from 2% to 57% and in the unvaccinated from 1.8% to 19.6%. However, they noted that no deaths occurred in the vaccinated men. They stated “We believe that the use of killed cultures as described prevented the development of the disease in many of our personnel and modified its course favorable in others.” The investigators concluded that B. influenzae played no role in the outbreak.

E. C. Rosenow (Mayo Clinic) reported on the use of a mixed bacterial vaccine in Rochester, Minnesota, where about 21,000 people received three doses of vaccine in his initial study. He concluded that “The total incidence of recognizable influenza, pneumonia, and encephalitis in the inoculated is approximately one-third as great as in the control uninoculated. The total death rate from influenza or pneumonia is only one-fourth as great in the inoculated as in the uninoculated.” He would go on to test his vaccine in nearly 100,000 people.

In an editorial entitled “Prophylactic Inoculation Against Influenza,” Journal of the American Association of Medicine editors warned that, “the data presented are simply too inadequate to permit a competent judgment” of whether the vaccines were effective. In particular, they addressed Rosenow’s paper:

“To specify only one case: The experience at a Rochester hospital—where fourteen nurses (out of how many?) developed influenza within two days (how many earlier?) prior to the first inoculation (at what period in the epidemic?), and only one case (out of how many possibilities?) developed subsequently during a period of six weeks—might be duplicated, so far as the facts given are concerned, in the experience of other observers using no vaccines whatever. In other words, unless all the cards are on the table, unless we know so far as possible all the factors that may conceivably influence the results, we cannot have a satisfactory basis for determining whether or not the results of prophylactic inoculation against influenza justify the interpretation they have received in some quarters.”


St. Louis took action early

St. Louis was the sixth-largest city in the USA with a population of about 756,000. News of the flu spreading through Boston, Philadelphia and other cities provided early warnings, and officials took notice.

"St. Louis had an energetic and visionary health official in Dr. Max Starkloff," Navarro says. The city's health commissioner "immediately started warning the public and told physicians to report influenza cases."

Starkloff, fully supported by the city's mayor, "was very quick to implement city closures," Navarro says. He closed public places such as schools, theaters, playgrounds, city courts and churches and banned gatherings of more than 20 people.

He canceled the city's Liberty Bonds parade. "They recognized that crowds were a danger," McKinsey says.

Businesses protested closings. "They were upset because they were losing revenue," McKinsey says. "It was a constant conflict between them and the city."

How many more deaths did Philadelphia have?

Estimated total deaths from influenza and pneumonia, September-December 1918:

SOURCE University Archives and Records Center, University of Pennsylvania Research Medical Center, Kansas City, Missouri

Though "Starkloff listened to business pleas to reopen, he didn't reopen the city all at once," Navarro said. "He did it in a step-wise fashion."

Starkloff reimposed restrictions as infection cases rose again in November 1918. Infections subsided, and restrictions ended in December. St. Louis fared better than other cities.

Which cities had highest peak death rates?

Estimated peak death rate per 100,000 population in 16 weeks for 1918 flu:

NOTE Excess pneumonia and influenza mortality rate, Sept. 14-Dec. 14, 1918, from 1913-17 baseline peak is the day with the highest number of cases SOURCE Proceedings of the National Academy of Sciences

Post-pandemic analyses revealed "social distancing was highly effective against virus transmission," McKinsey says.

"We also found volunteers had a great impact in dealing with the epidemic, especially the Red Cross, which did an excellent job in making masks, training nurse assistants and distributing medical information pamphlets to the public. It really made a difference," McKinsey says.

Total death rates of cities compared

Estimated overall death rate per 100,000 population for 1918 flu:

NOTE Excess pneumonia and influenza mortality rate, Sept. 14, 1918-May 31, 1919, from 1913-17 baseline SOURCE Proceedings of the National Academy of Sciences

Except for a minor fourth wave early in 1920, U.S. pandemic fatalities dwindled and virtually ended in the summer of 1919.

In the pandemic's aftermath, "we see a change in efforts for better public health," says Deanne Stephens, professor of history at the University of Southern Mississippi.

"It ranged from a greater emphasis on clean drinking water to the recognition that nursing was a critical service," Stephens says. "There was also the realization that government could take a stronger role in disease prevention."

Beyond that, Americans turned their attention elsewhere. Perhaps that was to be expected.

"There was a different mentality then," Stephens says. "The U.S. was used to epidemics. So in urban areas, there was an attitude of 'we're going to plow through this.' "

And finally, there was the shadow of World War I itself. Americans "may have thought of the flu as simply a subdivision of the war," historian Alfred Crosby wrote in "The Forgotten Pandemic."

Horror of 1918 flu faded

Subjects of stories in American periodicals after the flu (in inches of column space):

NOTE Prohibition was the ban on sale of alcoholic beverages in the U.S. Bolsheviks were far-left Marxist revolutionaries who killed the czar in 1917 and started a communist regime in Russia SOURCE The Readers Guide to Periodical Literature, 1919-1921, as cited in "America's Forgotten Pandemic: The Influenza of 1918" by Alfred Crosby.

SOURCES Centers for Disease Control and Prevention University of Pennsylvania, Archives and Records Center National Institutes of Health National Endowment for the Humanities Library of Congress Federal Reserve History Museum of American Finance National Bureau of Economic Research "When We Have a Few More Epidemics, the City Officials Will Awake," published master's thesis of historian Jeffery Anderson, Rutgers, 1997 "The Great Influenza: The Story of the Deadliest Pandemic in History" by John M. Barry, 2004 "Pale Rider: The Spanish Flu of 1918 and How It Changed the World" by Laura Spinney, 2017 "America's Forgotten Pandemic: The Influenza of 1918" by Alfred W. Crosby, 1989 "Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History" by Catherine Arnold, 2018 "Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History" by Dr. Jeremy Brown, 2018

USA TODAY research by George Petras illustrations and graphics by Karl Gelles